Provider Demographics
NPI:1356076103
Name:MANALO, RODWELL
Entity Type:Individual
Prefix:
First Name:RODWELL
Middle Name:
Last Name:MANALO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 STATION SQ
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8090
Mailing Address - Country:US
Mailing Address - Phone:908-355-4827
Mailing Address - Fax:
Practice Address - Street 1:29 STATION SQ
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8090
Practice Address - Country:US
Practice Address - Phone:908-355-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program